E-magine ePROs: Personalizing Care with Electronic Patient Reported Outcomes Collection · 2019. 7. 18. · E-magine ePROs: Personalizing Care with Electronic Patient Reported Outcomes

E-magine ePROs: Personalizing Care with

Electronic Patient Reported Outcomes Collection

Tran Truong, IT Manager Alyssa Macedo, Program Lead

Terri Stuart McEwan, Executive Director Madeline Li, Psychiatrist

1

Aim

To improve the quality and consistency of patient’s physical and emotional symptom management across the cancer journey

• Earlier identification and communication of symptoms

• Improved symptom management

• Improved collaborative care planning (Temel et al, NEJM, 2010)

• To empower Patients as Partners

Standardized symptom screening = Improved care

DART - Enhancing the Patient Experience

Ontario Cancer Symptom Management Collaborative (2008)-provincial benchmarking and public reporting; 70% of all cancer patients should be screened across Ontario.

Accreditation Canada (2009) New Standard in Practice- Evaluation and monitoring the clients emotional distress as the 6th vital sign

Ambulatory Care Strategy (2008-2015) improve the patient experience monitored with Picker Surveys; emotional support

Drivers for Change

DART - Enhancing the Patient Experience

ACTION

Development of the Distress Assessment and Response Tool (DART), a self report questionnaire which includes ESAS and other psychosocial measures (2009)

Reporting structure up to senior management team

Standard implementation in clinics with site based accountability

DART Personalized Assessment

Edmonton Symptom Assessment Survey (ESAS)

Patient Reported Functional Status (PRFS)

Patient Health Questionnaire (PHQ)

Brief Pain Index (BPI)

Generalised Anxiety Scale (GAD)

Social Difficulties Inventory (SDI)

VALIDATED ASSESSMENTS SELECTION CRITERIA

AGE - AYA < 40 - Geriatric >75

DISEASE SITE - Lung Cancer - Prostate Cancer

FREAQUECY - Every 7 days - Every 3 months

CLINIC LOCATION - Radiation Review - Blood Collection Lab

PROGRAMS - Survivorship - ALLO BMT

THRESHOLDS - Anxiety - Depression - Pain - Fatigue - Smoker

INTERVENTIONS - Radiation Fractions - Smoking Cessation

Patient identifiers and date

Edmonton Symptom

Assessment System Revised

(every visit)

Depression- Patient Health Questionnaire (PHQ) Anxiety- Generalized Anxiety Subscale (GAD) Distress Risk Factors

Social Difficulties Inventory

EVERY THREE MONTHS Is there a chance you would do something to end your life?

DART Report

7

DART Integration

DART Tech Implementation

• Started with touch screen kiosks (30): expensive and they take up a lot of space

• Mobile devices, iPads (85) • Enclosures • Charging • Security • Infection Control • Access (no internet) • Printing

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PM DART Screening Rate Quarterly Trends (2012- 2015)

PM DART screening rates have been maintained above 70% for 3 years

70% CCO Target

Approx. 9000 patient assessments completed/month

Foundations to Expansion and Sustainability

III. Commitment

to Communication

II. Integration of a Process Improvement Framework

I. Organizational and Leadership Commitment

12

88% 94% 94%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

The DART reports reflects my patients actual concerns

DART improved my ability to systematicall inquire about my patients' symptoms and

concerns.

DART Enahnces my ability to communicate with my

patients

Strongly agree/ somewhat agree

Neutral

Somewhat disagree/ strongly disagree

Impact on Staff and Patients

Improved Teamwork and Patient-Clinician Communication

Li M. et al, 2016

Advances in Program Development

Inter-professional Model Pain

of Psychiatry Active Initiative

Collaborative

Care (IMPAC)

AYA Nurse Triage

Future of DART

• Implementation in Montreal, Rossy Cancer Network, full french translation

• Integration with Patient Portal to complete at home

• Development of a clinic dashboard to view a summary of results

• Implementation in Vancouver Prostate Cancer Centre, Kuwait Cancer Control Center

• Interest from other international cancer centers

Acknowledgements to Team

DART Operations Committee Alyssa Macedo, DART Program Lead Terri Stuart-McEwan, Director of Ambulatory Care Bruce Campbell Patient/Volunteer Representative Kirsten Wentlandt, Regional Palliative Care Lead Simonne Simon, Advanced Practice Nurse Educator Julia Park, RA IPEHOC Tran Truong, HIR Manager Dr. Ringash (phone in), Oncologist/PRO Champion Dr. Madeline Li POPC Representative Sabrina Bennett, Manager of Ambulatory Care

DART IT Team Bruno Ramos, Technical Analyst Yuliya Gavrylyuk, Project Coordinator Lynette Chen, Support Analyst Justin Liu, Architect Viet Tran, Senior Analyst Chris Hamill, , Senior Analyst

Collaborators Doris Howell, iPEHOC Project Lead Dr. Bezjak, Lung Site Lead Dr. Geoffrey Liu, Radiation Oncologist Dr. Meredith Giuliani , Radiation Oncologist Janet Papadakos, Manager Patient Education

Robin Forbes, Social Work, Practice Lead Stephanie Phan, Clinical Lead, CRS Program

Iryna Tymoshyk, Ambulatory Manager

Jennifer Jones, Director, CRS Program Dr. Andrew Matthews, Senior Psychologist Dr. Tony Finelli, Urologist Dr. Abha Gupta, Medical Oncologist Dr. Andrew Hope, Radiation Oncologist Shabbir Alibhai, Senior Scientist